State-funded mental health services are only reaching 19 percent of eligible Texans. A shortage of funding for newborn screenings has contributed to delays for 75 percent of infants’ initial test results. And dozens of high-value contracts between state agencies and private consulting firms may not be legally binding because of paperwork errors.
These are among the findings in a series of reports that a key legislative agency, overseen by Texas House and Senate leaders, withheld from the public.
Since 2005, state lawmakers have received copies of the biennial reports, which are intended to improve the efficiency and effectiveness of Texas government, in the early days of the legislative session. Authored by the staff of the Legislative Budget Board, an agency that tracks how state funds are spent, the reports have led lawmakers to file hundreds of bills seeking to fix problems identified by state researchers.
But this legislative session, the reports weren’t made public — despite being completed months ago, according to people familiar with the documents. A spokesman for the legislative agency said it is up to its governing board, co-chaired by Lt. Gov. Dan Patrick and House Speaker Dennis Bonnen, to decide when the items will be published.
As transparency advocates sound the alarm about the specter of politically motivated censorship, the agency and its board have failed to offer an explanation for leaving the works unpublished. Both Bonnen and Patrick said they approved the reports for wide release, but the legislative agency they oversee declined to release them. (Update: The Legislative Budget Board published the efficiency report Monday evening after inquiries from The Texas Tribune.)
The reports are “fact-based, analytical audits of state policies that help all of us see where government can be more efficient and effective,” said Luis Figueroa, a former Texas Senate staffer and current legislative and policy director at the Center for Public Policy Priorities, a left-leaning think tank. “It makes no sense to censor LBB recommendations, which contribute to good governance of our state and responsible use of resources."
The Texas Tribune obtained copies of the efficiency reports, which discuss 36 topics and span 340 pages, after they were recently shared with a handful of lawmakers. They detail outcomes of a mixed bag of state government policies. Targeted pay raises for Child Protective Services caseworkers from 2016, for example, appear to have reduced turnover and improved agency morale, while a privatized system for providing health care to children with disabilities “has not met contract standards,” according to the authors.
With only seven weeks remaining in the 2019 legislative session, the absence of the documents, formerly compiled into a single Government Effectiveness and Efficiency Report, is striking. A crucial bill-filing deadline has already passed. And the state budget, to which lawmakers append “riders” that direct state agencies to make certain reforms, is nearing final negotiations.
Current and former legislators say the reports are a useful source of information in the lawmaking process. In 2013, for example, 67 of the 143 legislative recommendations compiled by the budget board were ultimately adopted, according to the agency.
“We used them, certainly, as a source, if not the only source,” said former state Sen. Bob Deuell, a Greenville Republican. “I always felt the [Legislative Budget Board] was pretty straightforward about things, and I always looked at it as being good information.”
This isn’t the first time that the report has come under fire from high-ranking politicians, but 2019 marked the first year for it not to be formally published or made available on the agency’s website until late into the legislative session. The Texas Tribune is posting the reports in full.
A 2017 dispute over reports
The efficiency report lay at the center of a political feud in 2017 between Patrick and then-House Speaker Joe Straus, the budget board’s co-chairs at the time.
Patrick, who has questioned why the budget board was even creating the reports, ordered the board’s director not to publish the findings. Straus, meanwhile, argued that the reports often contained useful information and directed them to be published anyway — under a new name, the LBB “staff report,” to make clear it did not have board members’ unanimous endorsement.
This session, the reports were kept from public view, but Patrick says that wasn’t his decision. A senior adviser, Sherry Sylvester, said the lieutenant governor’s staff had authorized the reports to be published online “months ago.”
“Lt. Governor Patrick’s concern has been that it be made clear to the public that the reports were written at the staff level and were not produced at the direction of the LBB Board and have not been endorsed by the LBB Board,” Sylvester said in an emailed statement.
A spokeswoman for Bonnen said the new House speaker authorized the budget board to publish the reports “after his election as Speaker” and that Bonnen shared the documents with state representatives and reporters who asked for them.
"These reports are a routine function of the Legislative Budget Board and are provided by request to Members of the Texas House each session,” spokeswoman Cait Meisenheimer said in an emailed statement.
Yet the the efficiency reports were apparently not cleared for publication until April, when the Tribune made clear it had obtained copies of the reports. In February, a spokesman for the legislative agency, R.J. DeSilva, told The Texas Tribune: “The timing of the release of reports and other material will be determined by our Board.”
The agency declined to provide the reports in response to an open records request, citing state law that allows unpublished drafts to be withheld from the public.
In a March interview with the Tribune, House Appropriations Chairman John Zerwas, a Richmond Republican who sits on the agency’s board, said he had not seen the efficiency reports. Asked why they hadn’t been released, Zerwas said he didn’t know, but “it could be that it’s politics that’s so far over my head.”
More on the findings
Several of the reports delve into Texas’ privatized system for Medicaid, a state and federally funded program that provides health care for poor Texans — mostly children and pregnant women — and people with disabilities.
One report found that Texas’ system had failed to provide a majority of Medicaid patients with certain mental health services that they should be eligible for.
Two health benefits, known as targeted case management and mental health rehabilitative services, are reaching less than 20 percent of Texans who should be entitled to receive them because of a diagnosis of serious mental illness, particularly schizophrenia and bipolar disorder.
Rehabilitative services, which provide training and instruction to help patients with mental illness remain fully integrated and functioning outside of a psychiatric hospital, mostly benefit adults. Targeted case management, in which health care professionals help patients access other medical, social and educational services, is mostly utilized by children.
“These are services that are meant to address the impediments to community integration, so helping a person get back to work, helping them build social relationships, those kind of things,” said Greg Hansch, executive director of the mental health advocacy group NAMI Texas.
The report found that while some patients may decline to receive services they are eligible for, a utilization rate under 20 percent suggests there are problems with the way private health plans are approving mental health care for patients, creating a barrier to accessing beneficial services.
Hansch said he was shocked to learn the report had been withheld from the public during a legislative session when Gov. Greg Abbott listed mental health care as an emergency item. The issue has also been championed by state Sen. Jane Nelson, a Flower Mound Republican who sits on the Legislative Budget Board.
“It’s just really important that evaluations like these be made highly accessible to all potentially affected stakeholders,” Hansch said. “My understanding is mental health was a priority this session, and this is pretty concerning.”
Another report found a lack of funding has held back a program for screening newborns for possible health conditions.
Texas screens babies for 55 conditions, 53 of which are detected through blood sample testing. But a lack of funding for testing kits has hampered the early detection of health problems, according to the budget board.
Texas charges health care providers a fee for screening kits that is not high enough to cover the costs of the program. For patients who are uninsured or have insurance through Medicaid, the state draws down a significantly higher rate of funding from the federal government to cover the costs. But lawmakers divert most of that funding away from laboratory screenings, leaving the state without enough funding to handle its workload.
The Texas Department of State Health Services laboratory only received 25 percent of initial-screen specimens within the targeted time frame of one day after collection. And Texas fails to screen for six conditions that the federal government recommends testing for, including spinal muscular atrophy, Pompe disease, MPS-1 and X-ALD.
“Failure to add conditions in a timely manner can prevent early detection of disorders, resulting in severe disabilities and death for some infants,” the report’s authors found.
A third report found evidence of errors in dozens of contracts that state agencies and public universities drew up with private consulting firms.
State law requires that if a state agency wants to hire a consulting firm, such as Deloitte or PricewaterhouseCoopers, for more than $15,000, it must have approval from the governor’s office. But researchers from the budget board found that some contracts were signed without the required approval process.
Consulting contracts also have certain transparency requirements that state agencies and universities are not following, according to the report.
As a result, dozens of high-dollar contracts may be “void” because they do not comply with state law, researchers found.
Disclosure: The Center for Public Policy Priorities and Sherry Sylvester have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.